Transesophageal Echocardiography

142 Pages·1987·3.822 MB·English

by  Norbert P. De Bruijn M.D., Fiona M. Clements M.D. (auth.)

TRANSESOPHAGEAL ECHOCARDIOGRAPHY
DEVELOPMENTS IN CRITICAL CARE MEDICINE AND
ANESTHESIOLOGY
Prakash, o. (cd.): Applied Physiology in Clinical Respiratory Care. 1982.
ISBN 90-247-2662-X.
McGeown, Mary G.: Clinical Management of Electrolyte Disorders. 1983.
ISBN 0-89838-559-8.
Scheck, P.A., Sj6strand, U.H., and Smith, R.B. (cds.): Perspectives in High
Frequency Ventilation. 1983. ISBN 0-89838-571-7.
Stanley, T.H., and Petty, w.e. (cds.): New Anesthetic Agents, Devices and
Monitoring Techniques. 1983. ISBN 0-89838-566-0.
Prakash, o. (ed.): Computing in Anesthesia and Intensive Care. 1983.
ISBN 0-89838-602-0.
Stanley, T.H., and Petty, w.e. (cds.): Anesthesia and the Cardiovascular
System. 1984. ISBN 0-89838-626-8.
Van Kleef, j.W., Burm, A.G.L., and Spierdijk, j. (cds.): Current Concepts
in Regional Anaesthesia. 1984. ISBN 0-89838-644-6.
Prakash, o. (cd.): Critical Care of the Child. 1984. ISBN 0-89838-661-6.
Stanley, T.H., and Petty, w.e. (cds.): Anesthesiology: Today and Tomor
row. 1985. ISBN 0-89838-705-1.
Rahn, H., and Prakash, o. (eds.): Acid-base Regulation and Body TClTI
perature. 1985. ISBN 0-89838-708-6.
w.e:.
Stanley, T.H., and Petty, (cds.): Anesthesiology 1986.
ISBN 0-89838-779-5.
de Lange, S., Hennis, P.J., and Kettler, D. (eds.): Cardiac Anaesthesia:
Problems and Innovations. 1986. ISBN 0-89838-794-9.
deBruijn, N. P., and Clements, F. M.: Transesophageal Echocardiography.
1987. ISBN 0-89838-821-X.
Graybar, G.B., and Bready, L.L. (cds.): Anesthesia for Renal Transplan
tation. 1987. ISBN 0-89838-837-6.
Stanley, T.H., and Petty, W.E. (cds.): Anesthesia, the Heart, and the
Vascular System. 1987. ISBN 0-89838-851-1.
TRANSESOPHAGEAL ECHOCARDIOGRAPHY
NORBERT P. DE BRUIJN, M.D.
Associate Professor
Department of Anesthesiology and Surgery
Duke University
Durham, North Carolina
FIONA M. CLEMENTS, M.D.
Assistant Professor
Department of Anesthesiology
Duke University
Durham, North Carolina
with a contribution by
RUSSELL HILL, M.D.
Fellow, Division of Cardiothoracic Anesthesia
Duke University Medical Center
Durham, North Carolina
MARTINUS NIJHOFF PUBLISHING
A MEMBER OF THE KLUWER ACADEMIC PUBLISHERS GROUP
BOSTON IDORDRECHT ILANCASTER
Copyright © 1987 by Martinus NijhoffPublishing, Boston.
Softcover reprint of the hardcover I st edition 1987
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, for transmitted in any form or by any means, mechanical,
photocopying, recording, or otherwise, without the prior written permission of the
publishers,
Martinus NijhoffPublishing, 101 Philip Drive, Norwell, MA 02061, USA
Distributors
for the United States and Canada: Kluwer Academic Publishers, 101 Philip Drive,
Norwell, MA 02061, USA
for the UK and Ireland: Kluwer Academic Publishers, MTP Press Limited, Falcon
House, Queen Square, Lancaster LAI lRN, UK
for all other countries: Kluwer Academic Publishers Group, Distribution Centre,
P.O. Box 322, 3300 AH Dordrecht, The Netherlands
Library of Congress Cataloging-in-Publication Data
Transesophageal echocardiography.
(Developments in critical care medicine and anesthesiology; 13)
Includes bibliographies and index.
1. Heart-Diseases-Diagnosis. 2. Transesophageal echocardiography.
I. DeBruijn, Norbert P. II. Clements, Fiona M. III. Hill, Russell, 1955-
IV. Series: Developments in critical care medicine and anaesthesiology; 13. [DNLM:
1. Echocardiography. 2. Ultrasonic Diagnosis. WG 141.5.E2 T772]
RC683.5.T83T731986 616.1'207'543 86-17959
ISBN-13: 978-1-4612-9206-7 c-ISBN-13: 978-1-4613-2025-8
DOl: \ 0.\ 007/978-\-46\3-2025-8
CONTENTS
Foreword by JOSEPH KrSSLO VI
Preface and Acknowledgments Vlll
Chapter 1 Development of Transesophageal Echocardiography
Chapter 2 Principles of Ultrasound Y
Russell Hill
Chapter 3 Cardiac Imaging from the Esophagus; 2-D Anatomy; Usc of the
Transesophageal Probe 29
Chapter 4 Clinical Applications of Transesophageal 2-D
Echocardiography 55
Chapter 5 Quantitative Analysis of 2-D Echocardiographic Images 85
Chapter 6 Doppler Echocardiography 119
Index 129
v
FOREWORD
Almost every effort in the care of patients with heart disease begins
with some description of disordered physiologic performance or mor
phologic anatomy. Since the early work of Edler and Hertz in 1954,
echocardiographic methods have grown in importance and reliability
for the diagnosis of many cardiac disorders.
The placement of a maneuverable transducer on the tip of a
modified endoscope is the result of relatively recent technologic
advances. The transesophageal approach is now a reality for obtaining
new information from ultra-sonic images of a beating human heart.
Since images obtained by transesophageal echo cardiography are
uniformly of excellent quality, it extends the diagnostic potential of
echocardiography to the patient who is difficult to image from the
conventional chest wall approach.
More importantly, transesophageal echocardiography provides a
means to acquire useful information in new situations, such as the
operating room. When this imaging modality is brought to patients
undergoing surgical procedures, surgeons and anesthesiologists have a
ready means for assessing cardiac performance during anesthesia,
directing various surgical approaches and immediately evaluating the
results of surgical repair.
Transesophageal echocardiographic techniques represent a major
vi
vii
advance in the care of patients with cardiovascular disease. Never
before has there been a means to acquire such important information
about the heart during an operative intervention. New questions are
being asked and new answers are at hand.
This book by Drs. de Bruijn and Clements captures these exciting
new developments as they explain the fundamentals and current and
future applications of transesophageal echocardiography. The authors
provide a timely definition of the practice through their insights and
experiences. Serious students or practitioners of the healing arts with
interest in cardiovascular disease will find this volume of extra
ordinary value.
Echocardiographic practice has generally fallen within the domain
of cardiologists, internists, or radiologists. The authors amply demon
strate that others with similar interest and enthusiasm expand our
knowledge of cardiac anatomy and function and ultimately improve
our care of patients. Although the impact of their efforts, and those of
their colleagues involved in similar pursuits, is yet to be funy realized,
they are likely to redefine the requisite fund of knowledge and skills
necessary for the practice of cardiovascular anesthesiology in the
future.
Joseph Kisslo
Associate Professor
of Medicine
PREFACE
This book, deriving from the experience of anesthesiologists, tends to
reflect the use of transesophageal echo cardiography as it has become
known in the USA. The reader should realize, however, that in
Europe the use of trans esophageal echocardiography has been almost
entirely in the hands of cardiologists. We have tried to present the
experiences of both specialists in this work and hope that both groups
will find it of interest. We believe that the full potential of transeso
phageal echocardiography at an institution can only be realized when
cardiologists and anesthesiologists have joint responsibility and in
terest in its use. Our own endeavors have been strongly supported
by Joseph Kisslo, who gave us not only the benefit of his own vast
experience in echocardiography, but also provided the administrative
leadership necessary to establish the use of transesophageal echo car
diography as a clinical service.
We are indebted to a number of other people whose special efforts
have facilitated the completion of this manuscript.
Michael Feneley and J. G. Reves provided us with ideas, inspiration,
and constructive criticism.
Nancy Henn, with the excellent illustrations, helped us to describe
the cardiac anatomy as it is seen with transesophageal echocardio
graphy.
viii
ix
Ann Hogan and Gail Brooks provided considerable patience and
understanding along with their secretarial assistance.
Lastly, we would like to thank the Diasonics Corporation, which
made a transesophageal imaging system available to us in the first
place.
TRANSESOPHAGEAL ECHOCARDIOGRAPHY